Philippines Suffers Setback in Promoting Breastfeeding

The Philippine Supreme Court has blocked a move to impose new limits on the marketing of infant formula. The new rules are part of a government plan to promote breast-feeding, which is declining in the Philippines and elsewhere in Southeast Asia. As Douglas Bakshian reports from Manila, many experts say babies in poor countries do best if their mothers breast-fed them.

Health officials say aggressive advertising by infant formula companies in the Philippines has many women believing that formula is better than their breast milk. To counter this, the Philippine Health Department expanded regulations to prevent companies from targeting parents with children under age two with advertising. The current regulations cover only parents with babies under age one.

The new rules also call for stricter labeling and sanctions on companies that do not comply. Health experts say companies have been able to market too widely, with ads that suggest formula-fed babies are more intelligent, more loving and better off than those raised on breast milk.

Infant formula companies have challenged the move before the Supreme Court, which is expected to make a final ruling by the end of the year.

The court has granted a temporary order to block implementation of the new code.

Under-Secretary of Health Alexander Padilla says there has been a large decline in breast-feeding in the Philippines, while sales of infant formula have grown. Padilla says only 16 percent of mothers now exclusively give breast milk to their babies for the first six months.

He says sales of infant milk formula now top $450 million annually, and last year the industry spent about $100 million on advertising in the Philippines. That is almost half the Health Department's budget of $239 million.

"This is really a question of public health against trade, or against profits and profit-oriented companies," said Mr. Padilla. "So we are really trying to respond to actual health concerns in the Philippines."

The Pharmaceutical and Healthcare Association, representing infant formula companies, has sued the Health Department. The association says that only Congress can change the regulations since it enacted the legislation on which they are based.

The association says it is not battling breast-feeding, which it describes as the "gold standard" for infant nutrition. However, it argues that when breast milk is not an option, then formula is an appropriate alternative. Felicitas Arroyo is an association lawyer.

"The devil is in the proposition that breast-feeding is an absolute, that there is no gray area in between," she explained. "So when they say that breast-feeding is an absolute, everything else is evil. The fact is infant formula [properly prepared] is hazard-free and risk-free for the users."

Even the U.S. Chamber of Commerce is joining the fight. In a letter to President Gloria Arroyo it warned that the Health Department's plan could risk the country's reputation as a stable destination for investment.

Health experts say breast milk is vital for babies in the developing world because clean water for bottle-feeding is a luxury and breast milk provides immunity to many diseases.

The World Health Organization (WHO) recommends that for the first six months mothers give babies only breast milk, and then combine breast milk with other foods until age two.

Research shows that babies on breast milk suffer fewer respiratory and intestinal diseases. The WHO estimates that 1.4 million babies die each year in poor countries because of low breast-feeding rates.

The Philippines is only one example of a broader trend across Asia, where just 35 percent of mothers give their babies only breast milk for the first six months.

Economics plays a large role. More women now work outside their homes, which makes it difficult to breast-fed, and since they have more income, they can afford formula.

Doctor Stephen Atwood, UNICEF health advisor for East Asia and the Pacific, says the trend is clear.

"Formula companies recognize a market when they see it," he said. "These rising economies where people are becoming more cash-oriented and where the economy is more of a cash economy, you find that they are an absolutely phenomenal market."

Thailand had the lowest breast-feeding rate during the first six months of childhood, at about five percent of mothers. UNICEF says Indonesia dropped to 39 percent in 2002, from 42 percent in 1997. In Vietnam, with a rapidly growing economy, breast-feeding dropped to about 19 percent in 2002, from 27 percent in 1997.

While the trend is going down in East Asia and the Pacific, other parts of the developing world are seeing a rise. In sub-Saharan Africa, for instance, the rate increased to 32 percent in 2004 compared with 15 percent in 1990.